Deck 29: Physiologic Responses of the Newborn to Birth

Question 1

A new grandfather is marveling over his 12-hour-old newborn grandson. Which statement indicates that the grandfather needs additional education?

A) "I can't believe he can already digest fats, carbohydrates, and proteins."
B) "It is amazing that his whole digestive tract can move things along at birth."
C) "Incredibly, his stomach capacity was already a cupful when he was born."
D) "He will lose some weight but then miraculously regain it by about 10 days."

Answer 1

"Incredibly, his stomach capacity was already a cupful when he was born."

Question 2

The nurse is assessing a newborn at 1 hour of age. Which finding requires an immediate intervention?

A) Respiratory rate 60, crackles present bilaterally
B) Pulse rate 145, systolic murmur heard
C) Mean blood pressure 55 mm Hg
D) Pauses in respiration lasting 30 seconds

Answer 2

Pauses in respiration lasting 30 seconds

Question 3

At birth, an infant weighed 6 pounds 12 ounces. Three days later, he weighs 5 pounds 2 ounces. What conclusion should the nurse draw regarding this newborn's weight?

A) This weight loss is excessive.
B) Weight loss is within normal limits.
C) Weight gain is excessive.
D) Weight gain is within normal limits.

Answer 3

This weight loss is excessive.

Question 4

A telephone triage nurse gets a call from a postpartum patient who is concerned about jaundice. The patient's newborn is 37 hours old. What data point should the nurse gather first?

A) Stool characteristics
B) Fluid intake
C) Skin color
D) Bilirubin level

Question 5

The nurse is planning care for a newborn. Which nursing intervention would best protect the newborn from the most common form of heat loss?

A) Placing the newborn away from air currents
B) Pre-warming the examination table
C) Drying the newborn thoroughly
D) Removing wet linens from the isolette

Question 6

When caring for the newborn after a vaginal delivery, the nurse needs to be able to identify the respiratory changes that occur during the transition of the fetus to extrauterine life. Which factors does the nurse recognize as contributing to the changes in the newborn's lung function after birth?

A) Adequate lung development and production of surfactant
B) Marked decrease in pulmonary circulation
C) Inspiratory gasp triggered by the elevation in PCO2 and decrease in pH and PO2
D) Stimulation of skin nerve endings due to chilling
E) Chemical stimulator associated with transient asphyxia of the fetus

Question 7

A postpartum mother questions whether the environmental temperature should be warmer in the baby's room at home. The nurse responds that the environmental temperature should be warmer for the newborn. This response is based on which newborn characteristics that affect the establishment of thermal stability?

A) Newborns have less subcutaneous fat than do adults.
B) Newborns have a thick epidermis layer.
C) Flexed posture of the term newborn
D) Blood vessels are closer to the skin.
E) Newborns have more subcutaneous fat than do adults.

Question 8

The nurse is teaching new parents how to dress their newborn. Which statements indicate that teaching has been effective?

A) "We should keep our home air-conditioned so the baby doesn't overheat."
B) "It is important that we dry the baby off as soon as we give him a bath or shampoo his hair."
C) "When we change the baby's diaper, we should change any wet clothing or blankets, too."
D) "If the baby's body temperature gets too low, he will warm himself up without any shivering."
E) "Our baby will have a much faster rate of breathing if he is not dressed warmly enough."

Question 9

The nurse is caring for a 28-hour-old newborn, and notes a yellow coloring of the skin. Which factors would the nurse consider as potential causes of the infant's physiologic jaundice?

A) Vacuum extraction delivery
B) Adequate calorie intake
C) Neonatal asphyxia
D) Congenital heart disease
E) Frequent bowel movements

Question 10

A telephone triage nurse gets a call from a postpartum client who is concerned about jaundice. The client's newborn is 37 hours old. What data should the nurse gather first?

A) Stool characteristics
B) Fluid intake
C) Skin color
D) Bilirubin level

Question 11

A 2-day-old newborn is asleep, and the nurse assesses the apical pulse to be 88 beats/min. What would be the most appropriate nursing action based on this assessment finding?

A) Call the physician.
B) Administer oxygen.
C) Document the finding.
D) Place the newborn under the radiant warmer.

Question 12

The nurse is caring for a newborn 30 minutes after birth. After assessing respiratory function, the nurse would report which findings as abnormal?

A) Respiratory rate of 66 breaths per minute
B) Periodic breathing with pauses of 25 seconds
C) Synchronous chest and abdomen movements
D) Grunting on expiration
E) Nasal flaring

Question 13

The nurse working in the delivery room is aware that factors relating to blood volume, hemoglobin, and hematocrit of the newborn include:

A) Delayed cord blood clamping.
B) Prenatal hemorrhage.
C) Temperature of the newborn.
D) Gestational age.
E) Site of blood sample.

Question 14

A newborn is determined to have physiological jaundice. The nurse explains the steps involved in conjugation and excretion of bilirubin to the parents. Which factors would the nurse include in the explanation?

A) At birth, the newborn's liver begins to conjugate bilirubin or convert it from a yellow lipid-soluble pigment to a water-soluble pigment.
B) Unconjugated bilirubin can leave the bloodstream and enter the tissues, causing a yellow hue to the skin and sclera.
C) Unconjugated bilirubin results from the destruction of white blood cells.
D) The infant is able to excrete conjugated bilirubin, but not unconjugated bilirubin.
E) The newborn's liver has greater metabolic and enzymatic activity at birth than does an adult liver, increasing the newborn's susceptibility to jaundice.

Question 15

The visiting nurse evaluates a 2-day-old breastfed newborn at home and notes that the baby appears jaundiced. When explaining jaundice to the parents, the nurse would tell them:

A) "Jaundice is uncommon in newborns."
B) "Some newborns require phototherapy."
C) "Jaundice is a medical emergency."
D) "Jaundice is always a sign of liver disease."

Question 16

The nurse has assessed four newborns' respiratory rates immediately following birth. Which respiratory rate would require further assessment by the nurse?

A) 60 breaths per minute
B) 70 breaths per minute
C) 64 breaths per minute
D) 28 breaths per minute

Question 17

The nurse is planning an educational presentation on hyperbilirubinemia for nursery nurses. Which statement is most important to include in the presentation?

A) Conjugated bilirubin is eliminated in the conjugated state.
B) Unconjugated bilirubin is neurotoxic, and cannot cross the placenta.
C) Total bilirubin is the sum of the direct and indirect levels.
D) Antibiotics decrease the incidence of hyperbilirubinemia.

Question 18

The mother of a 3-day-old infant calls the clinic and reports that her baby's skin is turning slightly yellow. The nurse should explain to the mother that:

A) Physiologic jaundice is normal, and peaks at this age.
B) The newborn's liver is not working as well as it should.
C) The baby is yellow because the bowels are not excreting bilirubin.
D) The yellow color indicates that brain damage might be occurring.

Question 19

The pediatric clinic nurse is reviewing lab results with a 2-month-old infant's mother. The infant's hemoglobin has decreased since birth. Which statement by the mother indicates the need for additional teaching?

A) "My baby isn't getting enough iron from my breast milk."
B) "Babies undergo physiologic anemia of infancy."
C) "This results from dilution because of the increased plasma volume."
D) "Delaying the cord clamping did not cause this to happen."

Question 20

The home care nurse is examining a 3-day-old infant. The child's skin on the sternum is yellow when blanched with a finger. The parents ask the nurse why jaundice occurs. The best response from the nurse is:

A) "The liver of an infant is not fully mature, and doesn't conjugate the bilirubin for excretion."
B) "The infant received too many red blood cells after delivery because the cord was not clamped immediately."
C) "The yellow color of your baby's skin indicates that you are breastfeeding too often."
D) "This is an abnormal finding related to your baby's bowels' not excreting bilirubin as they should."

Question 21

The nurse is teaching a group of new parents about newborn behavior. Which statement made by a parent would indicate a need for additional information?

A) "Sleep and alert states cycle throughout the day."
B) "We can best bond with our child during an alert state."
C) "About half of the baby's sleep time is in active sleep."
D) "Babies sleep during the night right from birth."

Question 22

The mother of a 2-day-old male has been informed that her child has sepsis. The mother is distraught and says, "I should have known that something was wrong. Why didn't I see that he was so sick?" The nurse's best reply is:

A) "Newborns have immature immune function at birth, and illness is very hard to detect."
B) "Your mothering skills will improve with time. You should take the newborn class."
C) "Your baby didn't get enough active acquired immunity from you during the pregnancy."
D) "The immunity your baby gets in utero doesn't start to function until he is 4-8 weeks old."

Question 23

The parents of a newborn are receiving discharge teaching. The nurse explains that the infant should have several wet diapers per day. Which statement by the parents indicates that further education is necessary?

A) "Our baby was born with kidneys that are too small."
B) "A baby's kidneys don't concentrate urine well for several months."
C) "Feeding our baby frequently will help the kidneys function."
D) "Kidney function in an infant is very different from that in an adult."

Question 24

A new mother is questioning the nurse about the newborn's urinary output, which is infrequent and scanty. The nurse recognizes this pattern as normal, and knows that contributing factors include which of the following?

A) The infant's glomerular filtration rate is high in comparison with the adult rate.
B) Full-term newborns are less able than are adults to concentrate urine because the tubules are short and narrow.
C) The ability to concentrate urine fully is developed at the age of 1 year.
D) Feeding practices can affect the osmolarity of the urine, but have limited effect on concentration of the urine.
E) The newborn kidney is limited in its dilutional capacity.

Question 25

A postpartum patient calls the clinic to report that her 3-day-old baby girl has a spot of blood on her diaper. The nurse explains to the mother that this is due to:

A) Withdrawal of maternal hormones.
B) A urinary infection.
C) An immature immune system.
D) Physiologic jaundice.

Question 26

The student nurse notices that a newborn weighs less today compared with the newborn's birth weight three days ago. The nursing instructor explains that newborns lose weight following birth due to:

A) A shift of intracellular water to extracellular spaces.
B) Loss of meconium stool.
C) A shift of extracellular water to intracellular spaces.
D) The sleep-wake cycle.

Question 27

A postpartum patient calls the nursery to report that her 3-day-old newborn has passed a bright green stool. The nurse's best response is:

A) "Take your newborn to the pediatrician."
B) "There might be a possible food allergy."
C) "Your newborn has diarrhea."
D) "This is a normal occurrence."

Question 28

The nurse is teaching a group of student nurses about the newborn and immunity, emphasizing that:

A) The newborn's immune system is fully developed at birth.
B) Hypothermia is a reliable sign of infection in the newborn.
C) The newborn has a good hypothalamic response to pyrogens.
D) Signs and symptoms of infection are often subtle and nonspecific in the newborn.
E) The newborn's immune system cannot recognize and destroy bacteria.

Question 29

When providing anticipatory guidance to a new mother, what information does the nurse convey about the newborn's neurologic and sensory/perceptual functioning?

A) Newborns respond to and interact with the environment in a predictable pattern of behavior, reacting differently to a variety of stresses.
B) The usual position of the newborn is with extremities partially flexed, legs near the abdomen.
C) Newborns do not react to bright light, and their eye movements do not permit them to fixate on faces or objects until they are 3 months of age.
D) Newborns have the capacity to utilize self-quieting behaviors to quiet and comfort themselves.
E) The newborn is very sensitive to being touched, cuddled, and held.

Question 30

A new father asks the nurse to describe what his baby will experience while sleeping and awake. The best response is:

A) "Babies have several sleep and alert states. Keep watching, and you'll notice them."
B) "You might have noticed that your child was in an alert awake state for an hour after birth."
C) "Newborns have two stages of sleep: deep or quiet sleep and rapid eye movement sleep."
D) "Birth is hard work for babies. It takes them a week or two to recover and become more awake."

Question 31

The nurse manager of the neonatal intensive care unit is preparing a handout for parents of ill newborns. Which statement should the nurse include?

A) Newborns can eliminate excess fluid as quickly as an adult can.
B) The kidneys are fully functional by 30 weeks' gestation.
C) Neonates have a tendency to become dehydrated.
D) Sugar is rarely present in the urine of a newborn.

Question 32

The nurse is teaching a newborn care class to parents who are about to give birth to their first babies. Which statement by a parent indicates that teaching was effective?

A) "My baby will be able to focus on my face when she is about a month old."
B) "My baby might startle a little if a loud noise happens near him."
C) "Newborns can taste sour things, like my breast milk will be."
D) "Our baby won't have a sense of smell until she is older."

Question 33

A new mother is holding her 2-hour-old son. The delivery occurred on the due date. His Apgar score was 9 at both 1 and 5 minutes. The mother asks the nurse why her son was so wide awake right after birth, and now is sleeping so soundly. What is the nurse's best response?

A) "Don't worry. Babies go through a lot of these little phases."
B) "Your son is in the second alert phase. He'll wake up soon."
C) "Your son is exhausted from being born, and will sleep 6 more hours."
D) "Your breastfeeding efforts have caused excessive fatigue in your son."

Question 34

The student nurse notices that the newborn seems to focus on the mother's eyes. The nursing instructor explains that this newborn behavior is:

A) Habituation.
B) Orientation.
C) Self-quieting.
D) Reactivity.